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Volume 31, Number 3—March 2025
Research

Model-Based Analysis of Impact, Costs, and Cost-Effectiveness of Tuberculosis Outbreak Investigations, United States

Sourya ShresthaComments to Author , Lucia Cilloni, Garrett R. Beeler Asay, J. Steve Kammerer, Kala Raz, Tambi Shaw, Martin Cilnis, Jonathan Wortham, Suzanne M. Marks, and David Dowdy
Author affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (S. Shrestha, L. Cilloni, D. Dowdy); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G.R.B. Asay, J.S. Kammerer, K. Raz, J. Wortham, S.M. Marks); California Department of Public Health, Richmond, California, USA (T. Shaw, M. Cilnis)

Main Article

Table 2

Descriptions, estimates and uncertainty ranges for parameters describing TB natural history, costs of TB outbreak investigations, and cost-effectiveness evaluation in study of impact, costs, and cost-effectiveness of TB outbreak investigations, United States*

Model parameters Point estimate Lower value Upper value Sources and additional notes
Characterization of TB natural history and the impact of intervention
% Contacts who will develop TB within 5 years after infection 6.6% 3% 15% Based on estimates of reactivation of LTBI among recent exposure (14) and among close contacts of TB patients (15). Lower value of 3% reflects uncertainty in the recency of the infection among contacts.
Efficacy of completed LTBI treatment 93% 70% 95% Estimates from 9H trial and noninferiority of 3HP compared with 9H (16,17).
R0 of cases detected during outbreak investigation 0.29 0.15 1.5 R0 of 0.29 from Shrestha et al. (12). Upper value of 1.5 for R0reflects outbreak settings with higher transmission.
% Reduction in infectious period through early detection
 50%
 25%
 75%
 Modeled as reduction in R0 based on higher case detection and notification in contact investigations (18), resulting in reduction in delays in TB diagnosis, a contributor to outbreaks (2).
Unit cost estimates, 2022 US$
Cost of PCR-based genotyping, per isolate $35 $25 $50 CDC (culture, typing, and identification by nucleic acid probe, amplified probe technique) (19)
Cost of outbreak investigation, cost per contact during outbreak investigation† $151 $86 $225 Unpublished data from 2 outbreaks in California (average cost of $106 per contact (2014 US$) (T. Shaw, unpub. data) (Appendix); unpublished CDC data reports mean cost of $175.90 ($78.00–$293.50) (2022 US$) (20).
Cost of LTBI testing per contact $71 $60 $80 Includes costs of IGRA LTBI testing, and costs of chest radiograph and TB test to rule out TB disease among those testing positive for IGRA (19,21,22).
Cost of LTBI treatment per infected contact $515 $300 $700 Includes costs of 3HP (23), laboratory testing, and toxicity both requiring and not requiring hospitalization (24). Assumes toxicity among 3.2% (20) of persons receiving LTBI treatment (25), and 0.015% requiring hospitalization (26).
Cost of TB treatment per contact with disease
 $23,543
 $15,000
 $30,000
 Direct TB treatment costs for non–MDR TB (27)
QALY estimates
Annual discount rate 3% Assumption
QALYs gained per TB case averted 1.16 0.74 1.39 Assumes 4.7% average mortality among people with TB, 36.3 years of average life expectancy at TB diagnosis, and health utility of 0.76 during TB treatment (28)‡;
QALYs lost per LTBI treatment 0.002 0.0015 0.0025 Jo et al. (20)§

*3HP, 3 months of isoniazid and rifapentine; 9H, 9 months of isoniazid; ARPE, Aggregate Reports for Program Evaluation; CDC, Centers for Disease Control and Prevention; IGRA, interferon-gamma release assay; LTBI, latent TB infection; MDR, multidrug resistant; QALY, quality-adjusted life-years; TB, tuberculosis. †Excludes costs associated with TB and LTBI treatment. ‡See Appendix for details on TB mortality rates; other data were incorporated to construct the range. §QALY estimate assumes toxicity among 3.2% of persons receiving LTBI treatment (25), and 0.015% requiring hospitalization (26).

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Page created: January 17, 2025
Page updated: February 21, 2025
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